Recognizing the Hidden Struggles: Unraveling ADHD and Neurodivergence with Dr. Antonia Strothers

May 20

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A Glimpse into Dr. Strothers' Practice

Dr. Strothers practices in Tenafly, New Jersey, situated in the northern part of the state. As a postdoc psychologist, she finds herself at the culmination of her training, with licensure on the horizon. Her practice operates within a group of clinical and school psychologists, providing a collaborative and supportive environment for both practitioners and clients.

Exploring Overlaps: Chronic Illness and Neurodivergence

One intriguing aspect of Dr. Strothers' work is the intersection of chronic illness and neurodivergence. She notes that it's not uncommon to encounter both in her practice, particularly among adolescents and adults. While the scientific underpinnings of this overlap remain a subject of ongoing research, it highlights the complex nature of chronic conditions and their potential connections with the nervous system. Dr. Strothers' practice is a testament to her dedication to helping individuals facing these unique challenges. Her expertise in providing support to both chronic illness and neurodivergent individuals creates a safe and nurturing space for those seeking guidance and understanding.

Debunking Misconceptions

One of the key takeaways from Dr. Strothers' insights is the prevalence of misconceptions surrounding neurodivergence. She highlights two significant myths that frequently surface in her practice:

The Straight-A Student Misconception

It's a common assumption that individuals with ADHD or autism must exhibit attentional deficits or autistic traits from an early age. However, Dr. Strothers cautions against this assumption. Many individuals, particularly those with neurodivergent conditions, develop coping mechanisms and masking strategies over time. These strategies can create an illusion of neurotypicality, with the individual achieving excellent grades without any apparent accommodations. Dr. Strothers emphasizes the importance of recognizing the internalized struggles that may not be immediately visible. This includes the emotional toll of masking or the extraordinary effort put into maintaining social norms.

Overlooking Gender Differences

Dr. Strothers also draws attention to the underdiagnosis of ADHD and autism in individuals who identify as female. This underrecognition is particularly prevalent in young adulthood, where many individuals, despite experiencing significant challenges, may not receive the validation or assessments they need. Providers may attribute their difficulties to mood-related issues or academic success, leading to missed opportunities for support and diagnosis.

Signs to Look Out For

If you're wondering how to identify potential neurodivergent traits in someone who has not considered an ADHD or autism diagnosis, Dr. Strothers provides valuable insights:

Excessive Preparation. Dr. Strothers often starts by exploring how individuals prepare for various tasks in their daily lives. It could be related to school, work, or everyday activities. People with neurodivergent conditions may invest a considerable amount of time and energy in preparation, sometimes without even realizing it. This intense preparation could indicate an attempt to fit into societal norms, often at the expense of their mental well-being.
Struggles with Routine Tasks. Individuals with neurodivergent conditions might face significant challenges in organizing their daily routines. Dr. Strothers encourages asking questions about how someone manages their daily tasks, what tools they use, and whether these routines are a source of stress or anxiety.
Social Interaction Patterns. Neurodivergent individuals may have distinct ways of socializing and interacting with others. Providers should look beyond surface-level symptoms like social anxiety or OCD and dig deeper into understanding an individual's unique social patterns and struggles

The ADHD-Anxiety Connection

Dr. Strothers highlights a crucial distinction between ADHD and anxiety: the origin of difficulties in focusing or staying organized. When someone experiences challenges due to fear or apprehension, it may point to anxiety-related issues. However, if these difficulties arise from becoming easily distracted, it could be indicative of ADHD. She emphasizes that ADHD, or Attention Deficit Hyperactivity Disorder, refers to a dysregulation in attention, a concept that may require a more accurate and descriptive name in the future.

A Change in Perspective

In the realm of neurodiversity, advocates like Sunny of "The Lived Educator" have proposed renaming ADHD as "Attention Hyperactivity." This alternative name reflects a more accurate understanding of the condition, emphasizing its core challenge—attention regulation.

Accommodations for Daily Life

Dr. Strothers also specializes in working with individuals dealing with chronic illnesses. Therefore she acknowledges that there is often overlap in symptoms. For example, fatigue and difficulties with organization. Whether these challenges arise from neurodivergence or chronic illness, accommodations can greatly improve an individual's quality of life.

Accommodations at Home

Spoon Theory:

Dr. Strothers approaches accommodations with a personalized perspective, recognizing that they can vary depending on an individual's energy levels and daily needs. She mentions "spoon theory," a concept commonly used in the chronic illness community. Spoons represent units of energy, and individuals have a limited number of spoons each day. Therefore, accommodations should be flexible and adaptable, allowing individuals to choose what suits them best on a particular day.

Examples of Home Accommodations

Medication Organization. For individuals taking multiple medications, organizing them for the week in a pill organizer can simplify the daily routine and reduce the cognitive load.
Task Breakdown. Breaking down tasks into smaller, manageable steps can help overcome feelings of being overwhelmed. For instance, simply moving clothes from the floor to the hamper in the bedroom can be a significant achievement on a low-energy day.

Accommodations at Work and School

Accommodations in these environments can be formal or informal, depending on the individual's needs and circumstances.

They may include:

Extended Time. Providing extra time for tasks, exams, or assignments can alleviate stress and improve performance.
Task Prioritization. Helping individuals identify and prioritize essential tasks can enhance productivity.
Flexible Schedules. Allowing flexibility in work hours or class attendance can be particularly beneficial for individuals dealing with chronic illness or neurodivergence.
Assistive Technologies. Employing assistive technologies, such as screen readers or dictation software, can be invaluable.

Parental Advocacy: A Powerful Force for Change

Dr. Strothers shares a personal anecdote from her education, highlighting the pivotal role parental advocacy played in her life. She acknowledges the support her parents provided and the positive impact they had on her journey. She emphasizes that being a strong advocate for a neurodivergent child can significantly shape their educational experience and future. Dr. Strothers encourages parents not to fear advocating for their children but to embrace their role as advocates.

Breaking the Stereotype of "That Parent”

She addresses the common concern among parents about being labeled as "that parent" when advocating for their child. Dr. Strothers challenges this stereotype, emphasizing that advocating for one's child is an act of love and support rather than something negative. Sometimes, advocating for a child may require getting loud or assertive. This should not be viewed negatively. She encourages parents to be the voice their children need, even if it means standing up against challenges.

A Message of Empowerment and Validation

Dr. Strothers reminds listeners that strengths matter just as much as areas of need. She encourages individuals to seek help, access available resources, and remember that they are not alone in their journey. Her personal and professional experiences underscore the importance of understanding the complexities of neurodiversity and the support that is available to empower and validate those navigating these challenges.

Remember, your strengths are a powerful force, and advocacy is an act of love and empowerment. You are not alone on this journey.

Disclaimer: Everything we discuss here is just meant to be general education and information. It's not intended as personal mental health or medical advice. If you have any questions related to your unique circumstances, please contact a licensed therapist or medical professional in your state of residence.

Destiny Davis, LPC CRC, is solely responsible for the content of this article. The views expressed herein may or may not necessarily reflect the opinions of the guest.

The content in this blog post comes directly from a real, human interview between Destiny and her guest on The Chronic Illness Therapist Podcast. This written version was formatted using AI. Listen to the full episode to hear the actual conversation.

Listen to my full conversation with Dr. Antonia Strothers on Ep 36: Confronting Misconceptions - ADHD and Autism accommodations in the school setting w/ Antonia Strothers, Psy.D., NCSP

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Episode transcribed with AI and may contain errors that are not representative of the actual word or meaning of the sentence.
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For specific questions related to your unique circumstances, please contact a licensed medical professional in your state of residence.
Dr. Antonio. Strothers began her career in school psychology in 2016. Being that she was diagnosed with a chronic illness and childhood herself. She had a strong desire to increase the knowledge, resources, and supports in the education system for children and adolescents with chronic conditions.
Dr. Strothers then decided to return to school, to advance her studies and move to clinical work. And thereafter obtained a doctoral degree in school psychology in 2020. She currently works full-time as a post-doctoral fellow providing psychotherapy and evaluations at a private mental health practice in Northern New Jersey. Her work most specifically focuses on chronic illness, anxiety, depression, grief, body image, and eating concerns.
As well as with neurodivergent individuals, she also strives to assist patients, parents, and families and navigating education. And related topics such as school post-secondary and college supports like iep is in five or fours as well as workplace accommodations.
why don't we start with you telling us a little bit about where you work, where you practice, who you kind of work with the most, and just anything else that feels important about you personally or professionally.
Sure. So I practice in Tenafly, New Jersey, which is Northern New Jersey.
And I'm a postdoc psychologist, which means that I'm at the end of my training very end, which is exciting. I should be licensed soon. And I, I work at a group practice with a number of other clinical and school psychologists as well, which is really nice. My background is in school psychology specifically, so I spent years prior to private practice working in public schools in New Jersey.
Pretty much pre-K till 21 years old, so I got a really nice range of Experience there. And then wanted to transition into clinical work a couple of years ago. So that's where I am now. I see, when you
say transition to clinical are you in private practice? Well, you, you said a group practice, but does that mean instead of working in the schools you are now kind of working in an office kind of talk therapy or.
Yep. Yeah, so we do, so I work yes in private practice. And I do mostly therapy, but I also do some assessment work as well. And sometimes I'll do consultative work too, just kind of helping families navigate things like special education services you know, workplace accommodations.
Transitioning to college and, and trying to determine what accommodations could look like there, things like that. So I have kind of a, a wide range of. Services I guess I can offer, but mainly therapy. That's just something that I'm most passionate about. So that's the bulk of my practice is talk therapy with children up until adulthood is kind of the, the age range I see.
Although I do probably see mostly children and teens. Again, that's just kind of. You know, the way that I like to format my practice given my school psych background, I really, really love working with kids and teenagers. So I typically take on more patients in those areas in that, those age ranges.
There's also not a lot of child therapists out there, especially those that specialize in chronic illness. So I really try to, to see a lot of those patients if I can. And I do, probably the bulk of my practice is working with neurodivergent children, so children with autism A D H D. And then I also do a lot of anxiety work as well.
And then of course, the other bulk of my practice is working with kids with chronic and adults with chronic medical conditions. Awesome.
And do you find that within chronic illness specifically, there is. Also a lot of a D H D or other neurodivergence happening?
I do. Yeah. I do see that quite often.
And I don't know exactly, you know, the, the science behind that. But I do know that it isn't uncommon, I think especially with autoimmune diseases because they are so complex to really impact people in a number of different ways. I think. Especially once people reach adolescents and above, it's, it's not Uncommon for them to have like numerous types of chronic medical conditions syndromes or also, you know, just be a neuro diversion individual as well.
And maybe there's a connection between the nervous system and, and how that works. But yeah, I do see that quite often. And are you able

to speak a little bit to when it comes to like assessing for ADHD or even autism as well, especially as an adult? Can you talk to I'm trying to think about how I wanna word the question.

When, so when you're assessing for this how, you know the difference between like, yes, you have adhd or these are symptoms that are happening as a result of, say, trauma or really stressful time in your life or something like that. How do you differentiate between those two? If, if at all. Sure. Yeah.

It, it can be complex. Certainly. So I think what's really nice if, if, if you can, is having access to a wide variety of assessment tools. And that doesn't necessarily have to look like, you know, your cookie cutter assessments that are. Scored and you know, that spew out a bunch of stats, but just really being knowledgeable in gathering background information, doing really good clinical interviews and things like that can be really important.

So you can really better understand when certain symptoms have begun. And what those look like over the course of a life, a lifespan, especially if there was trauma at some point or other kind of more, you know, medically related concerns happening as well. And so sometimes I find that really spending a lot of time early on in, in those testing appointments, gathering as much information as you can.

From as many reliable parties as you can, especially if you're working with a child is, is super important. So I always incorporate not only parents, you know, for children, but also any other providers that are necessary that really understand that you know, that child's brain and have. Worked with that child.

So if there is a therapist that child is seeing certainly teachers maybe a psychiatric provider, another medical provider specialist really covering all of your bases can be super helpful in those, in that, you know, that area. I hope that answered your question, but

yeah, it sounds complex and takes a lot of, it's not just a, a test you take.

And I think that that's a common misconception right now, especially with a lot of the, I see, I'm seeing them all the time now, ads for like, let's, like, I just saw one literally 30 minutes ago that was like, Online diagnosis for autism for your kids. And it's like, I don't know what that company does or how thorough they're gonna be, but I'm just seeing a lot more of these kind of like fast food kind of assessment websites popping up.

Yeah. Yeah, definitely it, it is concerning and I think a lot of people, especially with with autism and D H D, probably even a little bit more so with autism, though, I think, and I, I find this too, just even in consulting and things like that, I think people tend to think that they have a good understanding of what autism looks like.

And a lot of people don't especially with individuals that maybe have different needs and you know, have gone a long time without a diagnosis for various reasons and are now really, you know, feeling like that's something that they wanna explore, whether it's for accommodations or just. Because they want to have that information for themselves or they're self-identified.

Yeah, I think, I think it is something that, you know, it's, it's great. We obviously wanna have more people that are, that understand autism and can provide those services for people that wanna need them. But it is concerning that there are a lot of those, like kind of you know, maybe a little bit unethical, things that don't really look quite you know, I don't know what the word is, maybe Based in research or just, you know, that person might not have the clinical skills that you might want when, you know, searching for that type of a diagnosis.

Again, for whatever reason it is for that person. So definitely.

Can you talk a little bit about some of the misconceptions about what autism looks like and also what A D H D looks like? And then maybe talk a little bit to how that's playing out right now in like right now, a lot of people are searching for these diagnoses.

Yeah,

sure. So I think that there's a lot of misconceptions specifically with the social skill, I should say, using quotes there aspect of those diagnoses. You know, I'll hear often like, oh, you know, that person can't have autism, can't be autistic because they are making great eye contact. Or that person has so many friends.

What do you mean they, they're not on, you know, they're not autistic or, you know, that there's no attentional deficits. Because, you know, this person has gotten A's and B's their whole life in school without any accommodations. So I think those are big misconceptions that we hear often. And I think a lot of times people don't take into consideration things like masking especially as the child that, you know, child or individual gets older.

You know, people tend to learn unconsciously how to mask to protect themselves. From things like ableism that we, you know, hear so often in society. And so it could be that that person is heavily focusing, whether subconsciously or not, on trying to fit all of these cookie cutter standards that maybe neurotypical people feel.

Is what someone should look like, right? You know, in a social setting, whether it's, you know, really trying to maintain eye contact because that's something that they've heard that they struggled with for years when they were younger. Or, you know, taking hours and hours and hours to prepare for a class.

So that they can be the most attentive they can in that moment. So there is a lot of these internalized things going on that are very difficult to see, right? Because they are internal, unless the person has a pretty good understanding of what that looks like and can ask the right questions and explore that, what the person, whether it's in therapy or you know, if it's for an assessment.

And I also think then, you know, there's this other kind of. Area where. You know, people that identify as female tend to also be really overlooked with both of those diagnoses. So I think that, you know, that's something that we probably need to talk more about as well. I, I probably see if I could like, look back at my caseload from the start of my career till now.

Probably more you know, people that identify as women, especially in young adulthood, college age, I should say, and upcoming for those types of assessments. And that type of validation from an assessment for a diagnosis like a d h, adhd, autism, or both because they felt like they've been struggling with many things for years and, and have seen a new, you know, Numerous providers from different specialties that have just said, no, it's just mood related, you know, or your grades are great, like I said earlier, so you can't possibly have this or that.

So that comes up quite often too.

Yeah. How, how would someone know, like say someone comes in to, to see you for talk therapy, not an assessment and. What are some of the telltale signs that you might see in a client who they're not even, they're not even thinking about an ADHD DI diagnosis yet, cuz that's not even like something they have thought about, but you are sitting across from this person and you're like, this is evident, like this is really a big part of what you've been struggling with.

What are some of those telltale signs?

For me, I would say that's a good question. Usually I like to ask a lot of questions about. How long and what that person is doing to either prepare for something, whether it's school or work related, or just like everyday daily living tasks. That's something I really like to explore first, and I think it could be very quickly overlooked.

And it kind of ties into what I was saying before. You know, I think sometimes people don't even recognize. Because it just becomes so subconscious or they're just used to doing things that the way that they always have and that's, you know, that's what's typical for them, that they might be putting tons and tons of extra energy into just trying to fit into this cookie cutter neurotypical society that we all live in.

Without recognizing that that has added to a lot of. You know, mood symptoms stress, possibly burnout, whether it's again, school or work related or just daily living. And so sometimes I think we need to ask more questions like that, you know, what does that look like for you? How are you preparing every single day?

What tools are you using? Or is that working for you? Is that causing you more stress and anxiety? You know, and that could be, you know, something that could kind of lead to maybe talking about a diagnosis like that more or also just, you know, asking questions about how they feel like they learn how they feel like they you know, socialize and interact with other people.

Oftentimes people that might be neurodivergent tend to also get kind of either misdiagnosed or overlooked, because sometimes providers, I think, think that things like social anxiety or the only thing that's present or o c d is, is the only thing or the, or the thing that's present, let's say without really digging further under that surface and understanding, you know, more about.

What that looks like for that individual. How they kind of go through their everyday life and, and what aspects of that maybe are becoming way too difficult and, and just unmanageable for them because they aren't. Having access to the resources and the help that they might need, whether it's just within themselves or, you know, oftentimes the environment, right?

Just because, you know, the environment we do all live in tends to kind of be, you know, more easily accessible for people that are neurotypical or that don't have, you know, chronic medical conditions and things like that that aren't disabled. So, yeah.

Yeah. Would it be fair to say that if you had a client who was kind of.

Coming to you and just talking about how I'm thinking the typical, like, nothing's wrong with my life, but like, why do I feel this way? You know, it takes me so long to get out of bed or I just can't seem to get organized. Like I just, you know, I'm rushing around every morning and I know I should have a morning routine, but I just can't.

Like, are those kind of some of the things you might hear and would you add to

that? Yeah, no, I think that's, that's, those are definitely some things that I hear often and I think the overlap between an anxiety disorder and something, let's say like a D H D can be kind of tricky to differentiate.

Usually both are present in, in my opinion. Usually I always say like, usually there is. You know, an anxiety disorder or maybe even a mood disorder present because this person has lived without the knowledge and resources to help them, you know, feel their best, you know, function, you know, you know, functioning wise and just internally, you know, with that ADHD d diagnosis that maybe was never given to them or talked about and explored with them.

So usually that anxiety is kind of, Secondary to untreated adhd, essentially. And I think it's important to remember that maybe one of the main differences we should be looking at between, let's say h ADHD and anxiety is, are you having really trouble, are you having this trouble focusing or trouble saying organized because of strictly just something like fear or apprehension?

Or is it because. You find yourself becoming, you know, as an example, easily distracted. And, and that's I think, the key point that sometimes is super easy to overlook because even that, ADHD diagnosis, right? Like what does that mean? It's attention deficit hyperactivity disorder. That doesn't even really explain what that diagnosis is.

It really is a dysregulation in attention. And so I know I can go off on a tangent about this. I also have adhd. I didn't say that earlier. I'm nerd version myself, so sorry if I go on tangents, but yeah. I would hope that that diagnosis itself could even get changed to something that makes more sense in the future, essentially.

But yeah, I think distinguishing between those things can be difficult. But usually I think the anxiety and mood is, is quite often it's gonna be secondary to A D H D or autism. Those are neurological or neurodevelopmental disorders. We don't acquire them, you know, in life we're born, you know, those are the ways that our brains are born, so.

Right, right.

There's a Pretty big, like Instagram. She's autistic, adhd and she does a lot of advocacy around that. And sunny some something the lived Oh yes, the lived educator. Yeah. And they just posted yesterday, I think exactly what you just said. Like the, the name isn't right.

So their suggestion was just, ah, attention hyperactivity.

I love that. Yeah,

I was like, that's perfect. But yeah, so going back to the like a d h, adhd and then obviously we've been talking mostly just about a d g and, and autism this whole time. You also specialize in working with chronic illness.

That's my specialty as well. And while there's either, sometimes there's overlap, sometimes there's not. But I still think that the symptoms of like.

Fatigue and, and difficulty getting organized because whatever the reason is, whether it's cuz your brain is neurodivergent or because you're so fatigued cuz your body's, you know, fighting or whatever it is.

Can we talk a little bit about accommodations, just things that people can do for themselves at home, but then also accommodations at work and at school.

Definitely. Yeah, I think brain fog definitely comes into play, right? For a lot of those medical diagnoses that we probably both treat for sure.

So it can definitely look and feel quite similar to. Difficulties regulating attention. Cuz on some level, you, you are, whether you, you know, have a diagnosis of ADHD or not. So I think at home, you know, it, of course it's always tailored to the person. But sometimes I like to think that I, I like to use spoon theory when I'm also helping someone explore ways that they can better accommodate themselves.

Because it really can be different depending on that day, how many spoons they have, how much energy they have. I start with that conversation usually first. Because I don't wanna enter into that discussion with a patient. And the understanding on their end then the, that they have to like, maintain something that might be too unrealistic or difficult for them, even if it does seem wonderful, you know, in terms of accommodating themselves.

So I like to first start with, let's remind ourselves we don't have to necessarily follow all of the things we're gonna come up with on a daily basis. It can really be based on how you're feeling that day. But let's try to explore, you know, what might be best for you in general. And then we can think about what some things are on that list that are easier, maybe take less energy, less spoons to do, and then some of the other things that might be a lot more based on how you're feeling.

Or maybe you need to get some, you know, support from maybe from a partner or a parent. So at home it really could look, you know, something small. It could just be, let me think. Maybe just. You know, taking five minutes on a Sunday night to. You know, organize all of your medications in a little organized medic, you know I don't know what they're called.

I have one myself, I'm blanking. But like the little pill organizers that go from right like Sunday to, you know to Monday. So they're like seven day little pill organizers. So maybe you take a few minutes just to organize all of your medications for the week and that way every day you can just grab the one for that day and kind of go and not really have to think about it and not have to worry that you're gonna forget to take something.

Just that little time to start off your week, it'd be so beneficial for the entire week. So that's something that sometimes a lot of times people will, will find useful and, and that can be relatively, you know, simple and straightforward. Versus, you know, something that might be, that might take a little bit more energy.

Maybe you're putting off things like, you know, laundry or other chores around your house. And so maybe one day your goal is just to. Put some clothes from the floor of your bedroom into the hamper, and that's it. And then maybe you work up to a day where you have more energy and you could put those clothes in that washing machine, but maybe you're not ready to turn it on yet.

And so trying to break things down like that and see what's gonna be less overwhelming and, and more you know, accommodating for that individual. So there's just little things off the top of my head.

Yeah, I like that example because I think. When we start to talk about, I mean even the like taking five minutes to organize your pill box like I think it's important to illuminate sometimes what happens in our brains when we start to try to do these tasks.

And if you have a ton of medications and you even are like, okay, which one is one time a day? Which one is two times a day? Three times even? Or you know, I'm taking this one like, you know, for X, Y, Z and I'm taking this one for that. And it's a lot in your brain. And, and that alone could be a hindrance to why you might even do something that sounds so simple as.

Organize myself, take five minutes to do it for the whole week. And I think once we start to shed light on what is happening in the brain, like what that process looks like, it's like, oh, I feel seen, I feel heard. And this like obstacle, this mountain doesn't feel so, so high.

Yeah, absolutely. Yeah. And of course, as we know, right, if it feels that overwhelming, that's when the anxiety kicks in and then it's only going to further alter.

Our attention, right? Especially if we're already so fatigued or we're having brain fog. It's only gonna make things seem so much more difficult yet. And, and a lot of times in those situations too, especially for the, you know, my patients that I see virtually we will practice these things together in session first if it seems too overwhelming for them to do on their own.

So we'll do things together in session. You know, whatever that accommodation looks like, I can kind of help guide it, see if there's anything I could recommend that might make it even easier. So sometimes that's super beneficial for, for people as well. Sometimes I'll even do that if we're talking about like helping somebody with accommodations for school.

Especially college students. Once people go to college, they have to fill out and Access, figure out how to access those accommodations pretty much on their own, even if parents are helping, usually college disability offices will say, parents cannot fill out this paperwork, even if there's a release.

Like it has to come from the, the, the, you know, the child or you know, the young adult in that case, which is really ableist in of itself. But that's a whole other topic. So, you know, sometimes I will literally just have a session with a patient and we're just going to look through. That specific college, they're going to together, I will guide them with how to apply for those accommodations.

I will give them the letter they need from me in that session so they could do everything at once. They don't have to call anyone else, they don't have to submit anything else outside. We're doing it all together. And that could be really beneficial not just to take a lot of the burden off of them, but also for me to be able to guide them and how to do it on their own, you know, one day if that is something that they feel that they can do or need to do.

So,

Yeah, I agree. I've, I've done that with clients too, helping them fill out the paperwork in session. It just, there's just something about having somebody, well, it probably speaks to the body doubling concept where it's easier. Can, do you, can you explain that concept? And I know it's probably more of a social media term than like a clinical term, but

so, you know, I think.

That, that ability to really see things modeled for you and see the way that somebody is really breaking something down can be so beneficial to just take that and really learn and adapt it to their, to their lives. Even with young children that I see, if we're talking about, you know, how to you know, Help a child kind of stay more organized with the way that they're preparing for school in the morning in a way that's going to minimize any dysregulated behavior and things like that.

And maybe play therapy comes into play there too. But I think really being that stand in for that person, really showing them what that task looks like and, and the ways that you can execute it. Even in, in the number of different examples, if you wanna kind of give them, you know, some strategies that might be a little bit more difficult to start with or also break it down even further so they know, okay.

Like if something is really complicated, I don't have to necessarily, I. Go right into, you know, let's say like sending this email to this person at this disabilities office. I can just draft the email first. So I think that can be really useful, just being able to model that for them in that, in that way that's more individualized to what they need.

I don't, is that what you were asking? I'm, yeah. It's a

different concept, but that was really important too. Like, yeah, just being able to see something done rather than someone trying to tell you, go do this thing that's just so. I mean, it's, it's overwhelming and it's confusing. And so having someone to kind of hold hands in, in school, in schools, like, there's a concept, it's called scaffolding.

You kind of hold your hand until you're metaphorically hold your hand until you are completely capable of doing that thing on your own. And then you do it on your own, but then there might be the next step up that you're not able to do completely on your own. So again, we hold your hand until you're able to do that, and we just scaffold up the ladder until, so it's, it's not about pushing you.

To be like ultra independent. It's just, it's actually about

supporting you all the way through until

you genuinely feel capable of doing it on your own. Not just like, okay, I, I got it now. Like I can do it Cuz you're feeling shame about needing help. Yeah. So I think that concept is, is equally important.

And then in social media right now there's just this concept of body doubling. I don't know where the, the term originally came from, but it's essentially, I mean, there's even a Facebook group where like you just, you lo you like ask somebody, Hey, five o'clock tonight, like, let's get on a Zoom chat and we're not even gonna talk.

We're just both gonna do our own project. And it's like just having somebody else right next to you. Even virtually. It's like, okay, now I'm able to stay motivated and like do the thing that I'm trying to do. And I, for me, I just see that as like human nature, we, we thrive in community

especially supportive

community.

You know, community can also be, it can be really toxic too. But. I know for me even, it's like if somebody is here at my house, like I can, I can clean my whole house top to bottom, but if no one's home, like getting one foot off the ground is, it's like a brick weight on my

foot.

Yeah, definitely. That's interesting.

I haven't, I definitely wanna look into those Facebook groups. That's really cool. But yeah, I think too, like there's an aspect of that that's also. Some of these tasks might be so frustrating. Maybe it's not even that they're overwhelming or both right. But even if there's a person you know, who's coming to me and it's just like, it's not that I don't know how to know, I don't.

Not know how to do this thing. I just like cringe every time I think about doing the thing, I just like hate doing it. It's frustrating. I don't wanna get it done. I know I need to. Sometimes just being able, I guess in this case, right, like being that body double for that person to help with that productivity and even to show them like, okay, maybe this is really frustrating because it's so boring and I totally get that.

Let's figure out a way together to make this a little bit less boring if we can. And even just

having someone else there, that alone might be the thing that takes that boring edge off. Yeah. Yeah. But that's definitely a good addition to the conversation. Absolutely. Yeah. So we've talked about, we've talked about body doubling and, and mirror neurons, which is what we were kind of talking about before with having people show you the way When it comes to fatigue, again, regardless of the reason why, what are some of the things you help clients navigate when it comes to, again, whether, whether it's like getting appropriate accommodations or cuz we talk a lot on this podcast already about like Self-compassion and doing what you can and like navigating the, the balance of that.

And so I am more curious about maybe accommodations at work and of course fatigue looks different for every single person. So I know that's a, a broad question, but maybe you can even kind of describe a situation or a client of pre pretend client and then an accommodation that you might help them receive or try to receive.

That's a good question. Let me think.

So I can talk maybe a little bit too about the younger individuals I see too. Cause I think maybe I was speaking more to older individuals before, so that might be helpful too for, for this, for the listeners. But I get, and this might, we might wanna edit out for a second cuz now I'm thinking about this.

There's like, pause. No problem.

Lemme think fatigue. Okay, so let's say there I'm working with a child who is experiencing a. Tons of fatigue after school, which happens so often for a variety of reasons, whether it's the child's, like we were saying, it could be anything. But whether they're neurodivergent, whether there's medical issues going on, both you know, it's really difficult to sit in school for.

X amount of hours, seven plus hours for most kids, and then have to do homework after. And so that can be a really difficult and dysregulated time for a lot of kids, especially with fatigue and, and burnout at that time of day. So usually what I'll try to work with, with the school and, and with parents is seeing what that child can accomplish, you know, so maybe.

English. You know, reading and writing might be their favorite subject, so that might be something that they wanna start with first, because maybe it's easier for them. Maybe they really enjoy it, you know, certainly after like a break and a snack and all these other things that we talk about too. But just relating it back to the school side of things, what I'll tell parents is at the end of the day, Put post-its on anything that the child was not able to complete and send it back to the school.

And maybe the school can find a time to work with the child to reinforce some of those things if necessary. Or it's also a way for us to see, hey, maybe we have to modify this down. This might just be not realistic for this child right now. Do we have to give. 20 math problems when they can show that they understand well enough with five.

Right. So sometimes that could be useful too, is to just, and it takes a lot of the burden off of parents to feel like they have to sit there and force their kids to do all this work. That's just not, it's not realistic for that child and it's not necessary. So that's the way that I like to partner with, with the family and the school to help that patient.

See what they can do. Let's send anything back without fighting. We don't wanna hurt the child, parent relationship at all, you know, cuz that's really important obviously for first and foremost, in my opinion. Then getting homework done and then taking it from there. Do we need to modify further? Do we need to change the way that we've been giving this material?

You know, maybe. That child does need to have an audiobook, especially for those days that just sitting there and reading something for 20 minutes is way too challenging. And so we sometimes that can be really useful too, to figure out what accommodations are going to be best for that individual. You know, especially during a time that tends to be really, really difficult for most kids in those, you know, most kids that might have these other kind of unique needs.

That was perfect. Yeah. I really liked the example you started off with of like, maybe we start off with a subject matter that they enjoy and they like, and it, it just gives you momentum. Yeah. And I think a lot of times we, I mean we even have a lot of like, Sayings like eat, like eat, eat the frog or something.

It's like where you do like the fir the hardest thing first to like get it out of the way. But I think when you are always doing that, you're just like kind of teaching your body, like you have to fight. You're always having to fight so hard. And it, of course, again, it's individualized. So it maybe doing the fir, the hardest thing first is what works for you.

But I have found even for me too, that when I start off small and slow steps and build up, I'm gonna be able to get more done and it's not going to feel as like draining and just utterly hard.

Definitely. Yeah, absolutely. And I think too, for a lot of kids, the, the, the transition from school to home and then for many kids, you know, with activities then from an ac from, you know, home, back to another activity to back home, it's, it's a lot for a lot of children, especially if we're talking about neuro diversion children or children with, you know, disabilities.

So sometimes I'll even say, Okay, what's the heaviest day for that child? You know, maybe it's Tuesdays that they have two dance classes after school, or they have, you know, violet practice and then soccer. And those are things that, that child needs and wants to participate in. We don't wanna take them away from that if that's what they are thriving in.

That's, you know, away for them to access their, their specific interests. We don't necessarily wanna remove that. So maybe on Tuesdays the child is sent home with less homework because. They don't need all of it, you know? And so sometimes I think that could be useful too. I think sometimes in, at least on the school side, we just think about these like blanket accommodations or modifications in 5 0 4 s or IEPs, and it's so easy to not think about, well, what does this kid need?

And. How can we diversify it even amongst the days of the week for them, if that's what's best. So getting really creative and really incorporating what that child needs. And that also includes including that child in the conversations too, which I love talking about even little, little kids like. I start at the youngest ages, I can, you know, even if a child can't fully communicate of course with parent permission and consent to include them in that conversation, it's so important.

I think a lot of times people think that really young children can't possibly, you know, provide us with that information, but they're tiny humans and they're the most important person we're talking about. Right? To help. So that's a big piece too. Yeah,

I think that's so important. Thanks for mentioning that.

Especially if you're the type of person that does, has a strong resistance to like authority or, you know, nobody, nobody really likes, I shouldn't say nobody, but I. I know, I don't like being told Look to do. Yeah. I mean, I think some kids like thrive off of like very clear instruction and they kind of do want someone to say like, this is where you're gonna be and when you're gonna do this and that.

But I know I certainly never did and a lot of my clients same thing. So when you, when you invite the kid into the conversation, it just gives them a bit of, not even control necessarily. I mean, that's a part of it, but also just. It's prepping their brain for what's about to happen. We talk a lot about you know, low frustration tolerance, especially around transitions with A D H D autism, like transitions are really hard from one class to another or like to get in the shower or get out of the shower.

But I think a part of that, it obviously part of it's how our brain works and I think the other part is like we kind of just expect to like drag kids where we want them to go and they're just supposed to like, Be okay with it. We don't prep them, we don't, but when your brain is like aware of Oh, this is what's happening next.

It just gives you that what's the word I'm looking for? Comfortable comf. It makes you a little more comfortable with what's gonna happen cuz you're prepared. Definitely.

Yep. Absolutely. Yeah. It's, it's so funny too cuz I think oftentimes as adults we forget that, you know, There are a lot of things we're either asking children to do or wishing that they would or could do that we might not even be able to fully do on our own or like really you know, get pretty easily frustrated by Right.

Like, especially when I see some of my young patients with. Like all of these different responsibilities, most of which they really probably don't need to be doing. And I think, well, if that was how my life looked like right now, obviously in a more age appropriate way, I'm not gonna be doing like, you know, a couple, you know, filling in sentences and drawing pictures for homework.

But if my life look, looked that busy with all of those different things and responsibilities in that specific way, I would be really overwhelmed And task avoidant too. I'd be like, there's no way in hell I'm doing all of this. Like, you know, so why are we expecting them to? So yeah, I think that's really important too.

It's, yeah, just making sure that we're, we're really being realistic. You know, I, I love oh gosh. Oh, Ross Green, who's a psychologist, he, he's awesome. He talks about different, like, you know, collaborative problem solving with, with kids. And I, his biggest kind of statement I, I think is kids do well.

When they can or if they can, right. So if a child's really not doing well with something, it's probably because there not, because there is not probably, there is a reason why and we need to figure out what that is. You know, it's, it's probably something that, you know, is akin to putting too many responsibilities or unrealistic expectations on that child without also including them.

In the problem solving in those conversations to see how they're actually feeling and thinking about that thing.

Yeah. Yeah. And then to bring it back to like chronic illness and specifically with adults who have basically lived their whole life like this, where I. They didn't have someone advocating for what you're talking about right now.

So it was just, you show up, you sit down, you be quiet, you do as you're told. You go where you're supposed to go when you're supposed to do it. And so if you grew up like this, eventually you learn to shut down your impulses. Shut down your desire, shut down your wants and your needs, and you do just learn to like quote, fall in line, but you're miserable.

And your body is like screaming at you every day in a myriad of ways, whether that is exacerbated chronic illness symptoms or constant headaches, or just a lot of tension in your body. These things I think are all a result of a very restricted society. You know, haven't asked to go to the bathroom and not being allowed to sometimes, or not being allowed to eat when you're hungry.

And There is a little bit of like, if you eat every day at noon, like your body does learn to adjust and adapt, but everybody's just so different. Like you might truly need to eat at 10 and 12 and school doesn't allow for that. Or, so I think for adults who are, you know, just now learning how to, what we're, you know, we're talking a lot about lately reparenting your inner child.

It's, it's really this stuff like allowing your body to. Send you signals and tell you what it needs, and then figure out how to give your body what it needs, even though that's a really hard thing in the system that we're living in.

Yeah, absolutely. Definitely. Yeah. Even for me you know, growing up I had, you know, a pretty, I have a pretty complex medical history.

I, I tell this story often and I'll never forget. This is one of the reasons why I went into school psychology is, I was, I was on home instruction quite often and one time in high school I was, I think out for like almost three months. It was like the end of the year. And I remember this school calling my parents and saying, That I was likely going to have to repeat 11th grade because I had missed too many gym classes and I was pretty much bedridden for most of that time in an outta the hospital.

So I laugh now just because it's like that, you know, you have to, it's ridiculous. It's not funny, of course. And you, you think about that and you're just like, Where does this come from? Like where do these arbitrary rules and regulations and also how are you making that determination? I also never had like supports in school, like through a 5 0 4 i e p because.

I just, my parents just didn't know what that looked like and I, I, I didn't know as a kid. And so I didn't have those protections either. So, you know, that just I think, speaks to a lot with what we're talking about is, you know, it's really, really challenging when you're getting all of these really mixed or just super ableist.

Opinions and, and rules being placed on you for what you should and shouldn't be able to do. And you're just sitting there thinking, well, I can never amount to that cuz I can't physically do that. So then what, what else is left for me here? You know? So yeah, really supporting our clients in those ways is so important.

Especially, you know, you know, adult patients or older patients. Really thinking back to like what these moments looked like in childhood and how we can process that together. Yeah.

Yeah. How did you how did your parents, did you, you didn't repeat 11th grade, right? No. No, I did not. What was that fight like?

Or what was that conversation like?

Gosh, yeah. So my parents, I have great parents. I'm, you know, I'm, so, I certainly, the fact that I didn't have those supports, I don't want that to seem like my parents were like not supporting me. They just didn't even know that those things were apparent in school.

And this was like the, you know, Not that long ago, but like nineties, early two thousands. You know, things are changing a lot with like special education and accommodations and all that stuff. So yeah, that conversation was very much like my mom, I think like storming into the school, demanding to talk to the principal.

So it didn't go over well for

them. So she definitely advocated for me. She was like, yeah, that's never happening here, that we're not doing this. So I always felt fortunately like really supported by my parents in those ways. I just always knew I had an advocate there and I wasn't at any point.

I think that worried even at that age of like 16, that I was actually going to repeat. I think I even remember like being in bed and like laughing when my mom told me because she was like so angry and I was like, this is so.

Like, it's just funny for me, you know, as a teenager. So fortunately I, since my parents are

so awesome, I didn't have to really like, worry about that or see that, oh, this is a possibility, or, I'm not gonna have anyone that can advocate and support me here as I'm bedridden and, and confused and scared about this huge, you know, Shift in my educational future that I have to repeat this grade, right?

So I didn't have to really worry about that. My parents are great, but you know, that's not the reality for a lot of kids. And, and even in my case too, we still hold onto those things, right? Like you know, I, I didn't, I don't see that as a specific moment of trauma for me as opposed to some other things, just maybe because of the way my mom handled that so fast.

But sure, it was right. Like one of those things that. It did lead me to this career, you know, to really be a voice, not only for kids, but I love working with parents and being able to give them the knowledge and the tools to really be able to support their, their kids in school. And I, and I think most schools do want to help and do the best, but you know, they're limited too.

So working with the school, being that I know what it was like to be on the school side of things and helping the parents to help the child, it's really important. Yeah.

I think it's important for people to even hear like how your mom stormed into school and you know, is advocated for you because I think like depending on how you yourself were raised and now you're a parent, you might be too scared to do that.

So you might really, really want to advocate for your child and something similar might be happening. But if no one ever advocated for you and you were taught to just again, like shut up and follow the rules, essentially, you might have no, like, you are not gonna do that. But then maybe just someone hearing your story and it's like, whoa, her mom did that for her.

Like, I can do that too. Like it would be really hard, but I can do that.

Yeah, definitely. I talk about that a lot with parents. So often I hear from parents like oh, like I'm too nervous to say or do this thing. I don't wanna be quote unquote, that parent. And I spend a lot of time processing that with parents.

And ultimately we, you know, come to this understanding together where. That the idea of that parent, right, is a parent who is advocating for their child who is willing to fight. I'm not saying, you know, we have to do anything that's that, you know, we're not condoning violence or anything like that, but sometimes we have to get loud too, right?

And I think that's a another thing that people don't often talk about or maybe feel uncomfortable with because there might be this bias and maybe more so for women. That you know, oh, this, this, you know, this mother, let's say is, is. It's becoming really frustrated. And so we're gonna label that as bitchy.

Right. So I hear that a lot from moms, especially. Like, I don't wanna be that mom. And we, you know, I help them come to the understanding that that mom is actually the mom that they are and want to be and should be, you know? And sometimes we might have to get a little loud like my mom did, you know? And sometimes we don't, but we still advocate and we still.

You know, are that voice for that person. It's so important, especially for kids to be able to see that, you know, modeled for them and to have that, that advocate and to learn how that can look. You know, again, once they reach an age, if this is possible for that person to begin to advocate for themselves, it's so important.

Yeah.

Yeah. Absolutely. Is there anything else that comes to mind around this conversation that you'd like to talk about? Or that we haven't touched on today?

Yeah, I think, well maybe just on the school side of things too. The other thing I can think of is, you know, I see this like often asked a lot online and, and talked about and professional.

Circles is you know, how do we make a 5 0 4 planner an I e p more inclusive and really what it should be, which is individualized to that child but also in a strength-based way. You know, if, if you look at most 5 0 4 s or IEPs, they're probably just gonna heavily focus on weaknesses. And I also wanna preface this by saying sometimes the person in, in charge of.

You know, completing that document, whether they're called in New Jersey, we call them case managers, it might be called something else elsewhere. Sometimes that school professional doesn't necessarily have a lot of. You know, say in maybe how things are gonna get worded. They might be, you know, being told by like a supervisor or somebody that they have to kind of just word things in maybe a more weakness focused manner.

So I understand this might not always be realistic for everybody. But even if there's little changes that can be made that are much more strength-based and you know, student-centered that's a really. A wonderful way also to make sure you're not only supporting that child, but helping them understand what it is that they need in school, especially when they are included in those meetings, which I always recommend for kids, especially, you know, once they get to like middle school and above, if not sooner, if it's necessary, you want them to be able to see these documents and understand them.

It's really important. I used to teach my students. I was with high schoolers for a long time. I would literally like show them all of their i e P and explain to them what each section meant and things like that. It's so important when they, if they're going to college or applying to any of their accommodations after high school, that they really understand that and you want them to look at something that's strength-based and not just heavily focused on weaknesses.

Right. And so really trying to note like different abilities you know, they are, you know, the student is having difficulty with this versus they. You know, always have difficulty with this or, you know, the student is presenting with, with, you know, these unique needs, right? It's another way to kind of word things in a more inclusive manner.

And again, including them in those discussions and in their supports, getting their viewpoint and opinion and perspective is obviously always important. I know I sound like a broken record here, but we so often are like, I think schools are just, you know, there's so much on educator's plates and so it's really easy to like, Not remember to stop and think, wait a minute, did I even ask the student anything about this?

So it's so important to make them feel included and, and supported in that way too, to help them really advocate, and especially in post-secondary settings, to know what the disability looks like, what they need, and how to access those supports. Yeah. Yeah.

And just for listeners, another resource is the Job Accommodation Network.

I don't know if you use this. Do you use

this website? I have, yeah. Mm-hmm.

We used it a lot in my work as a clinical rehabilitation counselor. But yeah, it's not like the most robust site, but it is a good starting point if you just like, just don't even know where to begin and you can click on almost any diagnosis is kind of listed there.

And then I will say, or, or even just symptoms, like, I think it even has a category of fatigue.

So like,

Accommodations that you can, you can ask for if you have extreme fatigue or A D H

D or, and so

that's just one place to get started. But then also obviously working with someone who is well versed in accommodations.

So that might be a clinical rehabilitation counselor, although most of them work in like state agencies. But it also would be something like a school psychologist or is there, is there anything else you can think of that, like another professional that, that someone could reach out to?

Yeah, so sometimes I know in New Jersey we have this unique track for individuals that receive special education degrees and experience working as special educators where they can kind of go and get these advanced certifications.

They're called learning. I think, what is it? Learning Disabilities Teacher Consultants, L E T C is what we call them here. So sometimes those providers actually work not only in schools of course, but also they might do some private consulting work as well. And you know, those are individuals that have that firsthand experience with those children in the classroom.

And so they often have a lot of knowledge of IEPs. They're, they've. Been in charge of maybe case managing IEPs in the past, so that might be something to look into. Just, you know, for school psychologists specifically in general just for like general resources. I don't know if there's a place necessarily to find like consultant work, but the National Association.

Of school psychologists or nasp, their website has a lot of great resources as well for parents, for, you know, for professionals, for individuals. So that could be a nice place to, to look just for some resources there too. Yeah. Great. Thank you.

And is there anything you want to leave our listeners with today?

Piece of advice or any offerings that you have or just anything that you wanna leave them with?

Sure. I think, you know, really just trying to. Make sure we're remembering that our strengths matter, you know, not just our problems, not, not just our areas of need. We, we don't wanna make any assumptions about anyone else's abilities or competency levels.

I think that's a big thing too, that we talk a lot about. You know, language really matters and accessibility and accommodations are out there. And it's so frustrating that it can be so overwhelming and difficult to get that support, but there are people out there that are willing to help and that can help, whether it's online resources or someone you know, you can hire or you can connect with in person.

I, I like to always share too that if this might make someone feel a little bit more validated is, you know, I grew up with, with Crohn's disease specifically and some other medical issues later on, I'm an ADHD or. And I specialize in a lot of this work. You know, I was a school psychologist, like I said, now I'm in private practice and I had to access workplace accommodations in the past.

And despite all of that stuff, lived experience, professional experience, it was really stressful and overwhelming. So I understand like it really, the, the access to the accessibility is so overwhelming at times. And it's frustrating, but there are people that can help. There are people that get it.

There are ways to make it a little bit easier for you. And so, you know, don't shy away from getting that help if you feel like you can. Even if it just starts with a therapist to kinda help you guide, guide, help guide you through that is, you know, is something that's available oftentimes. And yeah, I don't know there's anything else.

Even just working through the shame like that comes up as a result of not being able to quickly or easily or seamlessly accomplish something like getting accommodations like a therapist. If, if all they're helping you with is shame, let's say they know nothing even about D H D and they're just working on with shame with you.

Yeah. That's still a great place to start.

Definitely. Yeah,
absolutely.
Awesome. Well, thank you so much for being here. It was such a pleasure to talk to you. I really appreciate your time.
Thank you. This is great.

Podcast cover art for "The Chronic Illness Therapist Podcast" with Destiny Davis, LPC CRC

Listen to Dr. Antonia’s interview with me, Destiny Davis, on Ep 36: Confronting Misconceptions - ADHD and Autism accommodations in the school setting w/ Antonia Strothers, Psy.D., NCSP